Sutter Health

To evaluate the outcomes of a street medicine intervention offering syphilis testing and treatment to people experiencing homelessness in South Los Angeles, California-a population disproportionately affected by syphilis and underserved by traditional healthcare systems. From September 2024 to January 2025, a multidisciplinary street medicine team provided testing and treatment for syphilis during outreach visits to patients experiencing homelessness. A total of 99 patients were tested using the reverse syphilis testing algorithm. Demographic data included gender, race/ethnicity, substance use disorder, mental illness and HIV status. χ2 tests were used to evaluate associations between syphilis diagnosis and each demographic characteristic. Thirty-six (36.4%) of the 99 patients had reactive syphilis test results, with 94.4% (n=34) classified as late-stage infections. Of those diagnosed, 72.2% (n=26) were treated during follow-up visits. Statistically significant associations were found between syphilis diagnosis and gender (p=0.002), substance use disorder (p=0.008) and HIV status (p=0.020). Patients identifying as female or transgender female, and those with cooccurring substance use disorder or HIV, were more likely to be diagnosed with syphilis. This study demonstrates the feasibility and outcomes of delivering sexually transmitted infection care through street medicine. The high prevalence of late-stage syphilis and its syndemic overlap with substance use disorder and HIV underscores the need for low-barrier, community-based services. Street medicine interventions should be recognised and resourced as essential tools in public health responses to rising syphilis rates, particularly among unhoused populations.

Limited literature focuses on delays in accessing head and neck cancer (HNC) care across the entire care continuum. This study aims to describe the time to care from symptom onset to treatment completion and identify predictors of delays for oral cavity cancer patients. We reviewed patients with oral cavity squamous cell carcinoma (OCSCC) treated with curative surgery followed by adjuvant treatment at a tertiary center. Delays were defined per published thresholds for: time to treatment initiation (TTI, diagnosis to surgery), time to adjuvant treatment (stratified by whether adjuvant treatment was at the same or different facility as surgery), and total treatment package time. We also measured symptom duration, reported median times, and used logistic regression to assess predictors of delay. Among 93 patients, median (IQR) symptom duration was 17.4 weeks (IQR: 6.8-42.8); TTI 6.9 weeks (IQR: 4.4-10.4); time to adjuvant radiation 8.4 weeks (IQR: 7.4-9.3) at the same institution as surgery was performed and 9.3 weeks (IQR: 7.4-14) at a different facility; and total treatment package time 15.4 weeks (IQR: 12.6-20) for surgery and adjuvant radiation, and 16.3 weeks (IQR: 15-18.6) for surgery and adjuvant chemoradiation. 73% of patients experienced delays in reaching a healthcare facility, 39% in TTI, 89% in starting adjuvant treatment, and 64%-81% in total treatment time. In univariate analyses, late-stage disease, residing in a community with higher social vulnerability index (SVI), longer time from surgery to pathology report, need for free flap, and social worker interaction were associated with higher odds of delay in any care interval following diagnosis. Higher SVI was associated with delays in multivariate analyses. HNC patients experience delays during all phases of cancer care. Interventions and future research need to address social determinants of health and health system factors that contribute to multifactorial delays across the care continuum.